Cognitive therapy or
cognitive behavior therapy is a kind of psychotherapy used to treat
depression , anxiety disorders , phobias , and other forms
of psychological disorder It involves recognising distorted thinking and
learning to replace it with more realistic substitute ideas. Its practitioners
hold that the cause of many (though not all) depressions are irrational
thoughts . Cognitive therapy is often used in conjunction with
mood stabilizing medications to treat bipolar disorder. According to
the U.S-based National Association of Cognitive-Behavioral Therapists:

With thoughts stipulated as being the cause of
emotions rather than vice-versa, cognitive therapists reverse the causal
order more generally used by psychotherapists. The therapy is essentially,
therefore, to identify those irrational thoughts that are making one unhappy and
what it is about them that is irrational; this is done in an effort to reject
the depressing thoughts and replace them with more accurate, but also more
cheering thoughts.

Cognitive therapy is not an overnight process. Even once a
patient has learnt to recognise when and where his thought processes are going
awry, it can take months of concerted effort to replace an invalid thought with
a more suitable one. But with patience and a good therapist, cognitive therapy
can be a valuable tool in recovery.

Cognitive behavioral therapy

While similar views of emotion have existed for millennia,
cognitive therapy was developed in its present form by Albert Ellis and
Aaron T. Beck in the 1950s and 1960s. It rapidly became a
favorite intervention to study in psychotherapy research in academic settings.
In initial studies it was often contrasted with behavioral treatments to see
which was most effective. However, in recent years, cognitive and behavioral
techniques have often been combined into cognitive behavioral treatment. This is
arguably the primary type of psychological treatment being studied in research
today.

A sub-field of cognitive behavior therapy used to treat
Obsessive Compulsive Disorder makes use of classical conditioning
through extinction and habituation Such a procedure has been used
successfully by Dr. Steven Phillipson to treat OCD. CBT has also been
successfully applied to the treatment of Generalized Anxiety Disorder and
Panic Disorder Depression

Negative thinking in depression can result from biological
sources (i.e., endogenous depression), modeling from parents, or other sources.
The depressed person experiences negative thoughts as being beyond their
control. The cognitive therapist provides techniques to give the client a
greater degree of control over negative thinking by correcting "cognitive
distortions" or thinking errors that abet them in a process called
cognitive restructuring Negative thoughts in depression are generally about
one of three areas: negative view of self, negative view of the world, and
negative view of the future. These comprise the cognitive triad.

The four column technique

A major technique in cognitive therapy is the four column
technique. It consists of a four step process. The first three steps analyze the
process by which a person has become depressed or distressed. The first column
records the objective situation. In the second column, the client writes down
the negative thoughts which occurred to them. The third column is for the
negative feelings and dysfunctional behaviors which ensued. The negative
thoughts of the second column are seen as a connecting bridge between the
situation and the distressing feelings. Finally, the fourth column is used for
challenging the negative thoughts on the basis of evidence from the client's
experience.

Treating depression with CBA

The newest and most effective cognitive and behavioral
therapy for depression is the cognitive behavioral-analysis system of
psychotherapy (CBASP). CBASP is a mix of several of the most successful
techniques. When combined with appropriate antidepressants, it can be extremely
effective.

A study published by Martin Keller MD of Brown
University et al in the May 18 , 2000 New England Journal of
Medicine compared the antidepressant Serzone with the talking
therapy, cognitive behavioral-analysis system of psychotherapy (CBASP). CBASP is
largely derivative of other talking therapies such as cognitive, behavioral, and
interpersonal therapy. Six hundred eighty-one patients with severe chronic
depression (some with other psychiatric illnesses) were enrolled in the trial,
and were assigned to either Serzone, CBASP, or combination Serzone-CBASP for 12
weeks. The response rates to either Serzone or CBASP alone were rather
underwhelming - 55 percent and 52 percent, respectively, for the 76 percent who
completed the study. In other words, a little more than half of the completers
in those two arms of the trial reduced their depression by 50 percent or better.

The Serzone findings roughly correspond with many other
trial results for antidepressants, and underscore a major weakness in these
drugs - that while they are effective, the benefit is often marginal and the
treatment outcome problematic. Similarly, the CBASP findings validate other
studies finding talking therapy about equal in efficacy to taking
antidepressants.

The results for the combination drug-therapy group,
however, were surprising, with 85 percent of the completing patients achieving a
50 percent reduction in symptoms or better. Forty-two percent in the combination
group achieved remission (a virtual elimination of all depressive
symptoms) compared to 22 percent in the Serzone group and 24 percent in the
CBASP group. The authors of the study confessed to being caught by surprise by
the results, acknowledging that "the rates of response and remission in the
combined-treatment group were substantially higher than those that might have
been anticipated".